Send us your before and after pictures for a FREE limited edition INSANITY T-shirt.

To receive your FREE INSANITY T-shirt, follow these instructions: 1. Complete this entire application. To qualify, you must complete all fields. 2. Email the completed application with before and after photographs of yourself (see Photo Details at the end the of form) along with your proof of purchase to SuccessStories@Beachbody.com, in compliance with the Terms and Conditions at the end of this form. 3. Proof of Purchase: To receive your FREE T-shirt, please provide one of the following proofs of purchase:
Your receipt Your packing slip Your picture with the INSANITY kit Your credit card statement

4. You may also mail the completed application with before and after photographs of yourself and your proof of purchase to this address: INSANITY T-Shirt Giveaway 3301 Exposition Blvd., 3rd Floor Santa Monica, CA 90404

Date:

Full Name:

Date of Birth:

Daytime Telephone:

Email:

Current Age:

Mailing Address:

City:

State:

ZIP Code:

T-shirt size:
(choose one)

XL

Note: Sizes are unisexfemales should order one size down from usual size. There will be no exchanges for the wrong size.

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Statistics:
Weight Size (pants or dress) Body fat percentage Chest (inches) Waist (inches) Hips (inches) Leg (thigh) (inches) Arm (bicep) (inches)

Before

After

Start Date
Program participation:

Completion Date

Where did you purchase your INSANITY program? Infomercial/Toll-free # Beachbody Web site Team Beachbody Coach Amazon.com Other (please specify) What was your main goal in using INSANITY? Lose weight Get lean and toned Improve cardiovascular performance Did you reach your goal? Did you work out alone or with others? Was INSANITY: As challenging as you thought it would be More challenging than you expected More moderate than you expected
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Yes Alone

No With others

Did anything surprise you about INSANITY?

What would you like to see from Shaun T next?

Would you like to be contacted by an Independent Team Beachbody Coach to learn how you can help others lose weight and get fit with INSANITY while making money at the same time? Yes No
Photo Details: The before photograph(s) should date from before you began the INSANITY program. The after photograph(s) must date from sixty (60) days after you began your program. You must have the legal right to submit the photos, the photos must be of you and not another person, you must be recognizable as the same person in both of the photos, and no other person(s) may be depicted in the photographs. Pictures should be head-to-toe full-body shots in exercise wear or bathing suits. Best if you send photos of front, side, and back views, but at the very least you should send a front-view photo. By submitting the photographs to Beachbody, LLC (BBLLC), you grant BBLLC, its affiliates, subsidiaries, representatives, assigns, employees, or any persons or corporations acting under its permission or authority, the right to publish, reproduce, distribute, create derivative works of, and/or otherwise use your name, statistics, biographical information, and photographs in any media now known or hereinafter devised, in such manner, for such purposes, and with such frequency as BBLLC shall determine in its sole discretion without further compensation or consideration to you and without further authorization by you. You represent that you are the sole owner of all rights in the photographs submitted. Terms and Conditions: You must be at least 18 years of age. To be eligible for the T-shirt offer, your submission must be completed in compliance with all instructions and these Terms and Conditions. Limit one (1) T-shirt per customer. BBLLC is not responsible for lost, late, damaged, delayed, corrupted, illegible, misdirected, or postage-due submissions. This offer is not valid if materials are not properly submitted in complete compliance with the instructions above and these Terms and Conditions. No substitutions allowed. BBLLC reserves the right to request additional information regarding any and all claims and supporting documents and to deny ineligible claims. BBLLCs decisions are final. The submission of false, incorrect, misleading, or fraudulent documentation may result in disqualification from this promotion and from future promotions and may be subject to review under U.S. Postal Regulations. The customer agrees to reimburse BBLLC for any T-shirt falsely obtained. T-shirt will be forwarded to qualified recipients via regular mail within eight (8) weeks after proper and complete submission. Incomplete or illegible submissions will be forfeited as ineligible. BBLLC is not responsible for any lost, damaged, or delayed applications. Keep copies of materials submitted; originals become property of BBLLC and will not be returned.

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